Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice

Fahim, Magid A., Hayen, Andrew D., Horvath, Andrea R., Dimeski, Goce, Coburn, Amanda, Tan, Ken-Soon, Johnson, David W., Craig, Jonathan C., Campbell, Scott B. and Hawley, Carmel M. (2015) Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice. Clinical Chemistry and Laboratory Medicine, 53 5: 715-722. doi:10.1515/cclm-2014-0838

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Author Fahim, Magid A.
Hayen, Andrew D.
Horvath, Andrea R.
Dimeski, Goce
Coburn, Amanda
Tan, Ken-Soon
Johnson, David W.
Craig, Jonathan C.
Campbell, Scott B.
Hawley, Carmel M.
Title Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice
Journal name Clinical Chemistry and Laboratory Medicine   Check publisher's open access policy
ISSN 1437-4331
Publication date 2015-04-01
Year available 2014
Sub-type Article (original research)
DOI 10.1515/cclm-2014-0838
Open Access Status File (Publisher version)
Volume 53
Issue 5
Start page 715
End page 722
Total pages 8
Place of publication Berlin, Germany
Publisher Walter de Gruyter
Collection year 2015
Language eng
Formatted abstract
Background: Changes in high sensitivity cardiac troponin-T (hs-cTnT) concentrations may reflect either acute myocardial injury or biological variation. Distinguishing between these entities is essential to accurate diagnosis, however, the biological variation of hs-cTnT in dialysis population is currently unknown. We sought to estimate the within- and between-person coefficients of variation of hs-cTnT in stable dialysis patients, and derive the critical difference between measurements needed to exclude biological variation with 99% confidence.

Methods: Fifty-five prevalent haemo- and peritoneal-dialysis patients attending two metropolitan hospitals were assessed on 10 consecutive occasions; weekly for 5 weeks then monthly for 4 months. Assessments were conducted at the same dialysis cycle time-point and entailed hs-cTnT testing, clinical review, electrocardiography, and bioimpedance spectroscopy. Patients were excluded if they developed clinical or physiological instability.

Results: In total 137 weekly and 114 monthly hs-cTnT measurements from 42 stable patients were analysed. Respective between- and within-person coefficients of variation were 83% and 7.9% for weekly measurements, and 79% and 12.6% for monthly measurements. Within-person variation was unaffected by dialysis modality or cardiac co-morbidity. The bidirectional 99% reference change value was –25% and +33% for weekly measurements, and –37% and +58% for monthly measurements.

Conclusions: The between-person variation of hs-cTnT in the dialysis population is markedly greater than within-person variation indicating that hs-cTnT testing is best applied in this population using a relative change strategy. An increase of 33% or a reduction of 25% in serial hs-cTnT concentrations measured at weekly intervals excludes change due to analytical and biological variation alone with 99% confidence.
Keyword Renal dialysis
Troponin T
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 20 Dec 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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